How much rates vary
Facilitymedian $91 · 10th to 90th $60 to $162Professionalmedian $60 · 10th to 90th $56 to $78
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $60.26 Median $83.18 Typical High $141.25 | Facility | None | $60.26 | $83.18 | $141.25 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $91.20 | Professional | None | $60.26 | $60.26 | $91.20 |
Anthem BCBS Setting Facility Modifier None Typical Low $66.07 Median $100.00 Typical High $199.53 | Facility | None | $66.07 | $100.00 | $199.53 |
Anthem BCBS Setting Professional Modifier None Typical Low $58.88 Median $58.88 Typical High $75.86 | Professional | None | $58.88 | $58.88 | $75.86 |
Blue Shield Setting Facility Modifier None Typical Low $60.26 Median $66.07 Typical High $102.33 | Facility | None | $60.26 | $66.07 | $102.33 |
Blue Shield Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $74.13 | Professional | None | $60.26 | $60.26 | $74.13 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $60.26 Median $66.07 Typical High $66.07 | Professional | None | $60.26 | $66.07 | $66.07 |
Cigna Setting Facility Modifier None Typical Low $60.26 Median $109.65 Typical High $151.36 | Facility | None | $60.26 | $109.65 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
Contra Costa Health Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $66.07 | Professional | None | $56.23 | $56.23 | $66.07 |
Kaiser Permanente Setting Professional Modifier None Typical Low $53.70 Median $57.54 Typical High $104.71 | Professional | None | $53.70 | $57.54 | $104.71 |
Lucent Health Setting Professional Modifier None Typical Low $54.95 Median $63.10 Typical High $102.33 | Professional | None | $54.95 | $63.10 | $102.33 |
Molina Setting Professional Modifier None Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | None | $52.48 | $52.48 | $52.48 |
Providence Setting Facility Modifier None Typical Low $60.26 Median $109.65 Typical High $169.82 | Facility | None | $60.26 | $109.65 | $169.82 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
Sutter Health Plus Setting Professional Modifier None Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | None | $69.18 | $69.18 | $69.18 |
United Setting Facility Modifier None Typical Low $60.26 Median $60.26 Typical High $128.82 | Facility | None | $60.26 | $60.26 | $128.82 |
United Setting Professional Modifier None Typical Low $46.77 Median $56.23 Typical High $67.61 | Professional | None | $46.77 | $56.23 | $67.61 |
8 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier 52 · Reduced service Typical Low $30.20 Median $43.65 Typical High $74.13 | Facility | 52 · Reduced service | $30.20 | $43.65 | $74.13 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $12.02 Median $17.38 Typical High $29.51 | Facility | 53 · Discontinued | $12.02 | $17.38 | $29.51 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $9.12 Median $13.18 Typical High $22.39 | Facility | 55 · Aftercare only | $9.12 | $13.18 | $22.39 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $6.03 Median $8.71 Typical High $14.79 | Facility | 56 · Pre-op care only | $6.03 | $8.71 | $14.79 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | 52 · Reduced service | $30.20 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $12.30 Typical High $12.30 | Professional | 53 · Discontinued | $12.02 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $9.12 Typical High $9.12 | Professional | 55 · Aftercare only | $9.12 | $9.12 | $9.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $6.03 Typical High $6.03 | Professional | 56 · Pre-op care only | $6.03 | $6.03 | $6.03 |
Where California sits
Rates are fairly even across states for this service. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
California· 42nd of 51
$60.26
AK $74.13OK $58.88
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.